Fingerprint instructions - Nevada State Board of Nursing

NURSING
Nevada State Board of
Instructions for Completion and Submission of Fingerprint Card
If you download an application from the Board’s website, a fingerprint card will be mailed to you upon receipt
of your application in the Board office. If you request an application by mail, a fingerprint card will be
included in that packet. You may choose to submit the fingerprint card at the same time as your application
but it is not necessary to do so.
1. All applicants must complete a fingerprint card (Form FD-258) provided by the Nevada State Board of Nursing (the
Board);
OR
If you fingerprint in Nevada, you may choose to have your fingerprints submitted via electronic transmission
(livescan) instead of submitting a card. Electronic transmission is only available if you have your fingerprints
captured in Nevada.
2. Complete the information block on the card, and make sure it is legible: last, first, and middle names; signature;
residence (complete address); citizenship; date of birth; place of birth; sex; race; height; weight; eyes; hair; and
Social Security number (if you have one). Cards without these information blocks completed are considered
“incomplete” and will be returned to the applicant. Illegible cards cannot be processed.
3. Fingerprinting on the Board’s coded card may be done by a law enforcement agency in any state or by a private
fingerprinting service. (The Board’s website www.nevadanursingboard.org has a list of Nevada fingerprinting
locations that offer electronic submission as well as fingerprinting on cards.) The Board provides fingerprint capture
by appointment in its offices.
4. Complete and detach the form on the reverse side, and send the fee and completed fingerprint card to the address
below. If you have your fingerprints submitted by electronic submission, you will make payment to the agency that
captures your fingerprints, but you must send a copy of your receipt to the Board.
5.
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Be sure:
You have your fingerprints captured at an in-state (NV) livescan location (recommended); OR
A fingerprint card is completed and the card is not folded, torn or damaged in any way.
The Information block is complete and legible
The card is signed by the appropriate persons (applicant and official)
The coded card (Form FD-258) provided by the Board is used exclusively
12-10-12
Please note: If you have previously been fingerprinted for your place of employment or another board of nursing,
we are unable to use those results. Federal law prohibits the sharing of fingerprint information. You will need to
be fingerprinted specifically for the Nevada State Board of Nursing.
WARNING: Due to various factors, it may take up to four months for the Board to receive the official fingerprint results
from the Department of Public Safety and FBI. A permanent license/certificate will not be issued prior to receipt of both
fingerprint reports. A temporary license cannot be extended beyond the 6-month expiration date. You are urged to
fingerprint early in the application process.
Fingerprint Submission Form
Mail to: Nevada State Board of Nursing, 5011 Meadowood Mall Way #300, Reno, NV 89502-6547 (888-590-6726)
If you completed a fingerprint card: Complete and attach this form and a payment of $50.00 to your completed fingerprint card
(Form FD-258). You may pay by credit or debit card (MasterCard, Visa, Discover, or American Express), personal or cashier’s check,
or money order, payable to the Nevada State Board of Nursing (NSBN), U.S. Funds only.
If you submitted fingerprints via electronic transmission: Complete this form and attach a copy of your receipt showing
payment for transmission.
First Name ________________________________________________Middle Name _______________________________________
Last Name________________________________________________________________ Date of Birth________________________
Address ____________________________________________________________________________________________________
City________________________________________________ State ___ Zip_________ Telephone Number __________________
Application Type:
RN
APN
LPN
CRNA
CNA
MA-C
EMS/RN
Licensed by:
Endorsement
Licensed by:
Other
Exam
Renewal
Renewal
If paying by credit or debit card, please complete:
Visa____ MasterCard___ Discover___ AMEX___ Card number___________________________ Exp. date_____
Name on card________________________________ Amount $50.00 Signature_____________________________